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Blood, 1 June 2001, Vol. 97, No. 11, pp. 3405-3410
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Controlled trial of filgrastim for acceleration of neutrophil
recovery after allogeneic blood stem cell transplantation from human
leukocyte antigen-matched related donors
Donna Przepiorka,
Terry L. Smith,
Jody Folloder,
Paolo Anderlini,
Ka-Wah Chan,
Martin Körbling,
Benjamin Lichtiger,
Frank Norfleet, and
Richard Champlin
From the Baylor College of Medicine Center for Cell and
Gene Therapy and the Departments of Blood and Marrow
Transplantation, Biomathematics, Pediatrics, Laboratory Medicine, and
Patient Care Business Affairs, The University of Texas M. D. Anderson
Cancer Center, Houston.
The rapid recovery of hematopoiesis after allogeneic blood stem
cell transplantation has been attributed to the quality and quantity of
hematopoietic progenitors in the blood stem cell grafts from
filgrastim-stimulated donors. To determine whether further stimulation
with filgrastim after transplantation would affect hematopoietic
recovery, a prospective, randomized, controlled study was performed.
Forty-two adult recipients of allogeneic blood stem cells from human
leukocyte antigen-matched related donors were randomized to receive 10 µg/kg per day filgrastim subcutaneously from day 1 through neutrophil
recovery or no growth factor support after transplantation. There was
no significant difference between the 2 groups in the number of
CD34+ cells infused (median, 4.8 vs
4.3 × 106/kg). Graft-versus-host (GVHD) disease
prophylaxis consisted of tacrolimus and steroids for 9 patients and
tacrolimus and minimethotrexate for 33 patients. The group receiving
filgrastim had a shorter time to neutrophil levels greater than
0.5 × 109/L (day 12 vs day 15, P = .002)
and to neutrophil levels greater than 1.0 × 109/L (day
12 vs day 16, P = .01). The filgrastim group also had a
trend for earlier discharge (day 16 vs 20, P = .05).
There was no significant difference between the groups in time to
platelet recovery, number of transfusions, regimen-related
toxicity, infection, incidence of GVHD, relapse, survival, or hospital
charges. It can be concluded that the administration of filgrastim
after allogeneic blood stem cell transplantation shortens the time to
neutrophil recovery.
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